Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 08349 | IA |
NPI | 1033202817 |
---|---|
Provider Name | Dr. William Thomas Souto |
First Address | Dubuque, IA 52001-4511 |
Second Address | Dubuque, IA 52001-3659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |